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EDITORIAL: Healthcare Reforms in Nigeria; A Mere Political Statement Lacking Commitment



By  Manny Ita

Nigeria has since her independence in 1960 had a very robust verbiage or policies by successive gobernments on health reforms but with very little progress or success recorded in what might well be a lack of political will in reforming the health sector.
Over 90% of the Nigerian population are without health insurance coverage. The inability to effectively address the country’s numerous public health challenges has contributed to the persistent and high level of poverty and weakness of the health system.
Political instability, corruption, limited institutional capacity and an unstable economy have also been major factors responsible for the poor development of health services in Nigeria. Households and individuals in Nigeria bear the burden of a dysfunctional and inequitable health system – delaying or not seeking health care and having to pay out of pocket for health care services that are not affordable.
The health challenges of the country include:
National Health Insurance Scheme (NHIS),
National Immunisation Coverage Scheme (NICS),
Midwives Service Scheme (MSS)
Nigerian Pay for Performance scheme
After many attempts at implementing legislation on health insurance since 1960, NHIS, although established in 1999, was eventually launched only in 2005 with the goals to ensure access to quality health care services, provide financial risk protection, reduce rising costs of health care services and ensure efficiency in health care through programmes such as the: Formal Sector Social Health Insurance Programme (FSSHIP), Mobile Health, Voluntary Contributors Social Health Insurance Programme (VCSHIP), Tertiary Institution Social Health Insurance Programme (TISHIP), Community Based Social Health Insurance Programme (CBSHIP), Public Primary Pupils Social Health Insurance Programme (PPPSHIP), and the provision of health care services for children under 5 years, prison inmates, disabled persons, retirees and the elderly.
The NHIS was expected to provide social and financial risk protection by reducing the cost of health care and providing equitable access to basic health services with the most vulnerable populations in Nigeria including children, pregnant women, people living with disabilities, elderly, displaced, unemployed, retirees and the sick.
Free health care services and exemption mechanisms are expected to provide financial risk protection for the most vulnerable populations but evidence suggest that they are ineffective and have failed to achieve this aim.
The maternal mortality ratio for Nigeria remain quite high at 814 per 100000 live births according to 2016 World Health Statistics. Across the country, pregnant women and children under five years are generally charged fees when accessing health care services, despite the federal government’s declaration of free health for pregnant women and children under five years in 2005.
The Minister of Health, Professor Isaac Adewole in 2016 announced the Federal Government’s plan to provide free health services to 100 million Nigerians in the next two years. Under this new health agenda, pregnant women across Nigeria are expected to enjoy free maternal and delivery services at the primary health care (PHC) level.
Unfortunately, Free health care services and exemption mechanisms often arise as campaign promises of political actors to the electorate and fall short in meeting the health needs of the most vulnerable populations. According to Nigeria Demographic Health Survey (NDHS) in 2013, over 60% of pregnant women aged 15-49 deliver their babies at home without any antenatal care visits. In rural areas, this value reaches 76.9%. The situation is critical in North East and North West regions of Nigeria where over 79% of pregnant women age 15-49 deliver their babies at home. Over 60% of pregnant women in Bayelsa, Plateau and Niger deliver at home rather than a health facility.
The cost of health care and the low quality of care by the public have been argued to be the reason for the poor utilisation of maternal and child health services in Nigeria.
In addition, health spending in Nigeria is low and this is responsible for the over-reliance on out of pocket payments for health care services.
Despite its launch in 2005, NHIS covers less than 10% of the Nigerian population leaving the most vulnerable populations at the mercy of health care services that are not affordable. This means the most vulnerable populations in Nigeria are not provided with social and financial risk protection. Poor people constitutes about 70% of the Nigerian population. They lack access to basic health services, which social and financial risk protection should provide, because they cannot afford it.
CBSHIP was expected to meet their health needs as well as provide social and financial risk protection to this group, which mostly reside in rural areas. As evidenced in the high rate of out of pocket payments for health care services , poor people financially contribute more to health care than official care and funds programmes in Nigeria. Out of pocket payments for health care services limit the poor from accessing and utilising basic health care services.
The quality of health care services delivered is poor and remains a huge source of concern. Most of the PHC facilities that are supposed to meet the health needs of the poor and rural dwellers are in a poor state due to poor budgetary allocation.
In trying to solve these issues, healthcare in the country must be tackled headlong in order to stem the detyeriorating development therein, which could portend grave danger for citizens of the country in the no-ditant future.
Policy makers and political actors need to devise health care reforms to address the lack of social and financial protection for the poor and vulnerable populations. Part of this reform is the expansion of the NHIS. States should be mandated to provide health insurance coverage to all residents. Making health insurance optional for states over the years has affected the ability of the NHIS to increase the level of coverage for the people.
While the mandatory CBHI scheme is being scaled-up as a supplementary measure, state governments should enrol poor residents in a private health insurance plan and bear the responsibility of paying the monthly premium per person to Health Maintenance Organisations (HMOs). It is not enough to have a national health insurance policy, it is important to ensure that health insurance coverage is provided to the poor and most vulnerable populations as a matter of the human right to health.
Although the NHIS Act made provision for children, who constitute the largest population in Nigeria, many children still have to pay for health care services in spite of being born into poor families that do not have the ability to pay for health care services and suffer financial hardship as a consequence. The free health policies and exemption mechanisms provided by some states, targeted at children, pregnant women and the elderly, are not social and financial risk protection policies, as these groups are largely responsible for the cost of health care with the free health care programme barely covering their basic health care services.
Another way of providing social and financial risk protection for poor and vulnerable populations is by establishing a legislative framework for a UHC scheme and setting aside funds for it. Evidence from Thailand has shown the effect of UHC schemes through PHC on expanding access to health care for the poor and vulnerable populations.
Political actors, policy makers and all stakeholders in the health sector should establish a government funded social and financial risk protection scheme through a general tax financing system for the poor and vulnerable, and invest in basic infrastructure for health care in rural areas for quality health care service delivery. UHC schemes are important in addressing the problem of poor coverage, limited access to health care, and poor quality of health care services.
Nigeria is yet to adopt innovative ways to protect the poor and vulnerable populations against financial risk of ill health. It is important to guarantee by law the right to health care of all citizens in Nigeria. Although the National Health Act (NHA) that was signed into law in 2014 stated that all Nigerians are entitled to basic minimum package of health care services, it is not clear if the provisions made in the NHA are capable of achieving UHC in Nigeria. In addition, the NHA is yet to be implemented over two years after its signage into law.
Some low- and middle-income countries (LMICs) have been able to provide social and financial risk protection schemes for poor and vulnerable populations as a matter of the human right to health. Therefore, there is a need to provide social health protection schemes targeted at these groups in Nigeria. The poor and vulnerable populations should not become impoverished because of failure to obtain much needed health care services. Governments must reduce out of pocket payments for health care services by households through the adoption of a tax financed non-contributory UHC scheme.

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By: Ade Balogun

In the twilight of the Amosun-led administration in Ogun State, the media was awash with the heartrending stories of the sufferings of the staff of Tai Solarin College of Education, Ogun State.

We were made to understand, through incontestable facts and figures, that the Ogun State Government owed TASCE staff about 64 months’ salaries. This revelation, coupled with some other excesses of former Governor Amosun, was a major factor in the defeat of his anointed governorship candidate, Adekunle AbdulKadir Akinlade of the APM, at the polls.

Despite gross intimidation, people voted for the incumbent Governor, Prince Dapo Abiodun with the belief that he would undo all the evils of Amosun, especially with his electioneering promise of giving the much needed succour to the staff of TASCE.

Shortly after the inauguration of Governor Abiodun, I was amazed to find the staff of the College still protesting the non-payment of salaries! My amazement turned into pure horror when I later learnt that five of the staff at the forefront of the protests were arrested and incarcerated!

My bewilderment grew in leaps and bounds when the Governor, in a media chat, actually acknowledged that he ordered the arrest of the five staff of the College to instill discipline and respect for constituted authorities, like former Oyo state Governor, Isiaka Ajumobi did to the students and staff of Ladoke Akintola University if Technology (LAUTECH), in the staff of the college. I was greatly disturbed by the Governor’s statements and position on the TASCE issue.

While I will not support anarchy in a system, it is simple logic that a man or woman that is being owed 64 months salaries cannot be expected to be rational. The fact is that the government actually created the state of anarchy through the non-payment of their salary arrears.

In the same vein, the best way to instill respect for constituted authorities is not through draconian actions but through consultations. Respect is different from fear. A government that toes the Machiavellian usage of fear, instead of love, to put the citizenry in a state of bondage will reap a harvest of pure and undiluted hatred.

With the aforesaid, I was greatly elated when I stumbled on an article in the Nigerian Tribune of 23rd October, 2019 titled ‘Dapo Abiodun: Silent restorer of education lost glory in Ogun’. TASCE featured prominently in the said article and the writer made us understand that the Governor had done the needful to return normalcy and sustainable peace to the college.

Given the fact that the staff of the college had stopped their protests, I had no cause to disbelieve the information. I immediately called one of my friends in the College to rejoice with him but to my utmost dismay, I was informed that the Governor has not paid a dime out of the accrued salary arrears and that since his inauguration on May 29, 2019, he has only paid half salaries for the months of June and July, 2019 despite the fact that the 1st semester examination has been held and that the 2nd semester is also about ending.

It was also learnt the Provost of the college, in person of Dr. Lukman Adeola Kiadese had been earmarked 50 million naira for the upcoming convocation of the college, which to be held on December 18, but amount to wastefulness and misplacement of priority, why don’t him expended the aforesaid money to pay the part of the money owing his staff of the college? the Provost also need to be cautioned in the way and manner handling the crisis of the college if he want normalcy to return to the institution and the government should also implement the report of the visitation panel, headed by Prof. Kamaldeen Balogun, by paying the Lecturers six months recommended in the report and call them to a round table and discuss modalities on how to pay the outstanding salaries’ arrears of the staff.

There is also heavy police presence in the college and anyone who dares to protest the inhumane situation in the college is either molested or queried. Why all these? At least, we are no more in military junta which also communicate through armed policemen or soldiers. But, I went back to check the name of the author of the article and I immediately understood my folly in taking the information contained therein on face value. He is no other person than Olamide Lawal, the political jobber who was fingered in the arrest of the five TASCE Lecturers.

If indeed the power strategy is the government’s plan to ensure peace in TASCE, then God should have mercy on all of us in Ogun State.

Balogun, wrote in from Ijebu-Ode, Ogun State.

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By: Anuoluwa Openiyi

It is no longer a strange phenomenon in Nigeria the extent to which deforestation is occurring in the wild. Deforestation is basically the cutting down of tress in the forest. It is a process where vegetation is cut down without any simultaneous replanting for economic or social reasons. These trees are known to be viable, useful, both for social, economic and developmental purpose. It is believed that Nigeria accounts for the world’s largest place where massive deforestation takes place.

Deforestation is not without any implication as it affects adversely on the social and economic structure of the country. Deforestation also has impacts on social aspects of the country, specifically regarding economic issues, agriculture, conflict, and amongst many other factors. According to data taken over 2000 to 2005, Nigeria, located in the western region of Africa, has the largest deforestation rates in the world, having lost 55.7% of their primary forests (Wikipedia online Resource, 2019). Whereas, primary forests can be seen as forests with no signs or trace of human activities. It can be rightly said that Nigeria has lost a huge part of her primary forest to deforestation due to human actions.

Deforestation in itself is something that is somewhat inevitable, but it will be rightly justified had it been there are adequate continuous re-planting of tree which are been cut down. As part of cases of cutting down of trees in Nigeria is that of ‘Shea Tree’. The Shea Tree is an economic viable tree which grows naturally on its own as it cannot be planted. It grows in specific places in some parts of Nigeria such as Niger, Oyo, and Kebbi States. In recent times, the Shea Tree faces severe victimization of deforestation as the tree is been cut on a large scale. The Shea Tree has economic importance. The fruits could be used for the production of Shea Butter, moisturizing-related products, and many other related items. It provides local employment and economic opportunities to women in rural areas, and also generates a distribution channel for one of its generating products; ‘’Shea Butter’.

Having involved myself to be among a group of social researchers who carried out an empirical study in Oyo and Niger States on the production of ‘Shea butter’ in 2018, certain discoveries were made. The process of this research allowed me to discover the danger the ‘Shea Tree’ is faced with as a result of deforestation. In the process of our findings, I did some photo-documentary of a number of ‘shea trees’ that were hewn already. Findings and field discoveries show that a large number of Shea Trees have been cut down on a large scale. Considering the fact the Shea Tree grows naturally on its own in specific places, the issue of re-planting is out the case. This poses serious challenge for local women who benefits economically from the Shea Tree.

There is a need for urgent step to be taken across board so as to prevent further cutting down of Shea Trees. It is time for policy makers, stakeholders, and academia to come up with policies which would be implemented for the safe-keep of this magnificent natural resource.

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“Our products capture the income brackets without compromising on standards or quality” – Temitope Mayegun, MD, Avila Naturalle



Mrs. Temitope Mayegun is a name synonymous with organically based skin care and hair products. In September 2016, God gave her the vision to begin what is now a household name in natural skin care and general beauty products. Three years on, Avila Naturalle has become the largest manufacturer of organic skin care and beauty products, commanding an elite place in the comity of cosmetic makers. With a thousand distributors of Avila products spread across Africa, Europe, Asia and the US, Avila is not resting on its oars as it plans on diversifying into food supplements next year.
Mayegun in this interview speaks about the upcoming Avila awards, the products and processes, challenges and other aspects of Avila Naturalle products. Excerpts:

The 2019 Avila Awards comes up November 9. Can you shed more light on the awards?

The Avila awards is all about appreciating our distributors; Our major and mini distributors who have worked hard throughout the year. We feel the way to appreciate their hard work is to reward them by giving them the awards and also other gifts. That is what Avila does every year and we’re committed to sustaining it.

What edition of the awards is the instant one?

This is the second edition of the awards. Last year was when the awards debuted.

There will be a training session preceding the awards. What does the training seek to achieve?

We have up to 1000 distributors both major and mini. Our mini distributors buy directly from our major distributors and deal directly with the end users. So it is important that they have product knowlwdege of what they are selling; about what Avila Naturalle is, what each product works for, to understand what Avila stands for; our vision, ethics etc, and importantly also to improve their entrepreneural scheme.
Recently you embarked on a CSR activity. Can you shed more light on that? 

The CSR is basically going to schools and telling them about the importance of maintaining their natural skin texture and impress upon them that they don’t need to alter their skin color to look beautiful, you know, and also let them know about the dangers in tampering into chemicalised products that damage the skin.
We were able to reach to 10000 students and gave them free coconut oil. The reason behind the CSR is because we discover that a lot of people have bleached their skins and have  issues. It is a well known fact that the market is saturated with chemical based products, so we need to sensitise young people about this. They need to be told to appreciate their skins, as beauty has no colour. 
We also went to the hospitals; many mothers would rather have these organic skin care products like ours for their children, but many do not have access to them and some can not afford them. So we gave free coconut oil to mothers, to babies, students and teachers . Its just our way of giving back to the society.

So is it correct to say that apart from beautifying, Avila natural skin care also restores?
Spot on. So many people who are tired of using chemicalised products due to bleaching, sunburn, stretchmarks, discoloration, pigmentation etc., and want to use Avila Naturalle. This set of people will have their skins go through a transition; a period that is not usually long. This is necessary for people whose skins have been depreciated by chemical products. The transition period allows the skin to return to its natural state. What bleaching does is to expose the skin to the sun and all kinds of skin infections. Our products will first of all restore such skins back to their original natural state before beginning the beautification process to make the skin glow. On the othet hand, those who have not used these chemical products for long, with no marked visible effects, have no need of transition. Their skins will naturally begin glowing as they use our products.

How affordable are Avila products?

We have products that are very affordable, compared to other organic products and also very effective. We do large scale production. We also deal with local farmers. So the synergies we have in place make our prices competitive. We have products that sell for N250, N500, and so on. Our products capture the income brackets without compromising on our standards and quality.

How many distributors are you looking to reward this year?

We are looking forward to host 300 distributors. That is up by 200 from last year. Our distributors in Ghana and other African countries will be here. Others from the UK and other parts of Europe will also be here. Our US distributor called that she would not be able to make it due to issues demanding her attention at the time. From all over the country, Africa and other parts of the world, our distributors will be coming for the awards.

Any new products in the offing or any other development?

Right now we have up to 200 products in the market; different products for different people. We have our salon range which is new in the market, baby set, men range etc. We just launched 7 new products, hibiscus toner, lemon body straw, lemon face cream, lemon toner etc. We have products for everybody, when you talk about hair care, baby care, women body care and so on, Avila’s got it all.
We also hope to begin the production of food supplements by the first quarter of next year, so its not just about cosmetics but also healthy bodies.

How much more do you think you can stretch your sensitizing initiative or your CSR, given the gravity of the damaged skin synd?

We have a sales team right now and what they do is to go into markets to talk to people and tell them about these products; we have also done a lot of PR activities this year going to TV stations, radio stations, and telling them about organic products. Those who use our products usually do referrals as well. However, I am also thinking about other means of continuing this and publications about it from you guys will also help.

What are some of the challenges you have as a manufacturer of organic skin care products?

When we started, people were just being introduced to organic products and as I told you, the market is saturated with chemical products and people just don’t see why they should maintain their skin complexion. So acceptance was a challenge; getting people to undertand that organic products do not work the way chemicals work, getting them to know that organic products are best for their skins and general welfare. There were other challenges, like having the right staff. There was no company as big as us now, when we began, to have perhaps got mentoring from. In terms of the vision that we have, I looked around but there was no company that had gone ahead, from whom we could learn. The few then were not running theirs the way we intended to, since ours is a big vision. We had to depend on God, do a lot of research, share the vision to staff so we all can work with the same passion and frequency, and get people to see the vision the way God gave me.
Another challenge is in the area of raw materials. I have always said this and will continue to. Our soil does not support the plants we use, many of which are imported, so right now I am looking to begin the production of indegenous plants, which hopefully should set off next year, that is our ‘vision 2020’. We have six acres of land where we work with local farmers but even so, we still need access to raw materials as almost all the plants for essential oils are imported. Another challenge yet is that of space and a good challenge you’d agree. Right now we are working on a new and bigger factory. Access to funds is another one. However, the biggest challenge is getting people to accept organic products. The long time effect of bleaching is cancer, and the increase in cases of breast cancer results from skin bleaching.

Do these chemicalised products bear NAFDAC numbers? If they do, isn’t it a problem for the industry?

What NAFDAC can regulate is what you give them. They are trying in terms of ensuring compliance with good manufacturing practices. Some of these chemical products even hide under organic facade. Some of them also are not registered under NAFDAC. Many of the ingredients they use have been banned in many other countries. So the cosmetic industry really needs good regulation.

What is the unique angle about Avila?

We are truly natural. We follow good manufacturing practices. We use standard operating procedure in all our formulation and we do not compromise. We are not just all about making profit but also concerned about customers’ skins. Avila is a well structured company with different departments; a standard factory, raw materials department, packaging department, media, administration departments and so on. We ensure that every product is safe to use. We try to give the best always because all our raw materials are 100 percent organic. Many today call chemical products organic, but organic starts from farming. We do not add fragrance to our oils. There are a lot of adulterated cosmetics. Avila harvests its products and processes them into what they are. We do not add chemicals to our products. A lot of people who have used our products see the positive effects and speak for us. Many companies are trying to compete with us but we are not moved because we are original and we care. We have 1000 distributors as we speak, We have about 70 staff, while 26 of our products have gone through NAFDAC analysis. So we are not a one-room company, augmenting its credibility with the internet, but a unique company, unique in every sense.

Avila is also providing opportunities for business and entrepreneurship, with your farms, distributorship etc., Was this in the original plan or fell in line with the progress of things?

Avila is a vision that God brought to us in Nigeria. I was in a secular employment when God told me to go and start working on herbs and plants for skincare and general well being of the skin and hair.
God is part of Avila. He gave the vision. I have not sold anything prior to taking off with Avila. I have no skill in selling as all my life I have always been an office person. So I want to believe it is the hand of God on the business that is making it prosper. We try to ensure we keep our commitments to our distributors no matter how inconvenient, with commissions and other rewards.

You apparently have an effusive working relationship with your staff. Can you explain this?

Its an observation many have made. I believe there should be a good working relationship between the MD and the staff to allow for a free work flow. I don’t believe that workers need to quiver before their MD’s. When a conducive atmosphere has been created, the work flows well. You can easily get ideas from them because they can easily relate with you. There are errors you might be at the verge of making which, owing to the good working ambience, they could help avert, otherwise they’d probably just watch you get into the ditch. However, I am a stickler for correctness. I do not joke with due diligence. Whatever the company achieves is a collective achievement. It also helps them add value, because once they notice that their input is recognised and appreciated they would do more.

Any plans to get Avila listed on the stock exchange?

That is in our plans and we’re looking forward to hit that milestone very soon.

Have you had any case of production mishap?

We have had one or two cases of production errors but were quick to remedy them. For instance, there are some products which when exposed to the sun for a long time lose their stability. In such cases, what we do is to recall such products from the market.
How can the government assist in making the industry better?
The government of Nigeria needs to support the Natural skincare products sector, seeing that people are now going natural. We have taken our products everywhere around the globe and also meaningfully contribute to the GDP of the country. We’re a pride to the nation. So it will go a long way if the government can provide fertile lands for us, on which organic plants can be grown. With that we would cover more grounds, get bigger and provide more employment and business opportunities.
We have products that you cannot see anywhere else in the world. For instance, our organic leather cleaner, you cannot find it anywhere else. I did a research on it and it is a hundred percent organic. We  also have Bitter Guard Oil which is good for pile. Excepting one Egyptian company, that also cannot be found anywhere else. Apart from these, we also have our bar soap for laundry which is purely organic and not the type of chemicalised ones you see in the market. This also maintain the colour of clothes, as it contains no harmful chemical.
So, yes, government support is needed. NAFDAC has been supportive. They gave a lot of advisory services when they were here; telling us what to do to maintain good manufacturing practices, ensuring that our products are free from micro-organisms. I believe they are trying, but can do more.

Any advise to potential customers out there?

For potential customers, they need to know that the organic beauty products are way different from the chemicalised products. Organic skin care products do not work as fast as chemicalised products do, but in the long run, organic based products will promote their general well-being as their skin and hair will not age on time. Most of our products promote collagen. We don’t just dabble into products. We have right now products that are still going through research and development. As it were, some customers are asking for snail serum and it is not as if we cannot have that in the next 24 hours, but as a matter of policy, we subject products to research in order to ensure that they do not have long term negative effects on the skin. They should know Avila is here to give them the best. We are the best organic skin care brand. Avila cares.



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